Arthroscopic surgical device

ABSTRACT

An arthroscopic bone channel forming and suturing method including forming a first generally straight channel in a bone, forming a second generally straight channel in the bone, the second generally straight channel not intersecting the first generally straight channel, inserting a curved needle into the first generally straight channel, inserting a suture through the second generally straight channel in the bone to a suture pick-up location, manipulating the curved needle to form a curved junction between the first generally straight channel and the second generally straight channel; and pulling the suture by the curved needle from the suture pick-up location through the junction and though the first generally straight channel.

REFERENCE TO RELATED APPLICATIONS

Reference is made to the following U.S. Provisional Patent Applicationwhich are believed to be related to the present application, thecontents of which are hereby incorporated by reference herein andpriority of which is hereby claimed under 37 CFR 1.78(a)(4) and (5)(i):

U.S. Provisional Patent Application Ser. No. 61/802,958, entitled“Arthroscopic Surgical Device” and filed Mar. 18, 2013.

U.S. Provisional Patent Application Ser. No. 61/887,561, entitled“Arthroscopic Surgical Device” and filed Oct. 7, 2013.

Reference is also made to the following PCT Patent Applications and U.S.Provisional Applications which are believed to be related to the presentapplication, the contents of which are hereby incorporated by referenceherein:

PCT Patent Application No. PCT/IL2013/050030, entitled “ArthroscopicSurgical Device” and filed Jan. 15, 2013;

PCT Patent Application No. PCT/IL2012/00031.8, entitled “ArthroscopicSurgical Device” and filed Aug. 23, 2012;

PCT Patent Application No. PCT/IL2012/000319, entitled “Circular BoneTunneling Device Employing a Stabilizing Element” and filed Aug. 23,2012;

Published PCT Patent Application No. WO 2012/007941, entitled “CircularBone Tunneling Device” and filed Jul. 11, 2011;

U.S. Provisional Patent Application Ser. No. 61/636,751, entitled“Circular Bone Tunneling Device Employing a Stabilizing Element” andfiled Apr. 23, 2012;

U.S. Provisional Patent Application Ser. No. 61/526,717, entitled“Circular Bone Tunneling Device” and filed Aug. 24, 2011;

U.S. Provisional Patent Application Ser. No. 61/714,81 3, entitled“Arthroscopic Surgical Device” and filed Oct. 17, 2012; and

U.S. Provisional Patent Application Ser. No. 61/584,267, entitled“Circular Bone Tunneling Device” and filed Jan. 8, 2012.

FIELD OF THE INVENTION

The present invention relates generally to arthroscopic surgical devicesand more particularly to arthroscopic bone tunneling devices.

BACKGROUND OF THE INVENTION

Various types of arthroscopic surgical instruments are known for variousapplications including orthopedic surgery.

SUMMARY OF THE INVENTION

It is appreciated that the terms ‘tunnel’ and ‘channel’ are usedinterchangeably in the description of the present invention and refer toa hollow bore, such as a cylindrically circular hollow bore, formed in abone. It is also appreciated that the terms ‘tunneling’ and ‘channeling’are used interchangeably in the description of the present invention andrefer to a method of forming a hollow bore, such as a cylindricallycircular hollow bore, in a bone.

It is further appreciated that the term “suture” as used throughout thedescription of the present invention refers to any suitable suture andalso refers to a transfer wire which is used to pull a suture throughthe bone. Typically, a transfer wire is used with the system and methodof the present invention and is formed of Nitinol. Typically, a transferwire used with the system and method of the present invention is foldedover to form a loop at one end.

The present invention seeks to provide an improved arthroscopic bonetunneling and suturing device.

There is thus provided in accordance with a preferred embodiment of thepresent invention an arthroscopic bone channel forming and suturingmethod including forming a first generally straight channel in a bone,inserting a curved needle into the first generally straight channel,forming a second generally straight channel in the bone, the secondgenerally straight channel not intersecting the first generally straightchannel, inserting a suture through the second generally straightchannel in the bone to a suture pick-up location, manipulating thecurved needle to form a curved junction between the first generallystraight channel and the second generally straight channel and pullingthe suture by the curved needle from the suture pick-up location throughthe junction and though the first generally straight channel.

Preferably, the inserting the suture includes locating a folded over endof the suture at the suture pick-up location. Additionally oralternatively, free ends of the suture extend outside of the secondchannel.

In accordance with a preferred embodiment of the present invention thesecond generally straight channel is substantially longer than the firstgenerally straight channel.

Preferably, the curved needle has a radius of curvature which isgenerally equal to or greater than a length of the first generallystraight channel. Additionally or alternatively, the geometry of thecurved needle and the geometry of the first generally straight channelare such that the curved needle can pass through the first generallystraight channel without changing the configuration of the firstgenerally straight channel to add curvature thereto. Additionally, thegeometry of the curved needle includes its width and its inner and outerradii of curvature and wherein the geometry of the first generallystraight channel includes its width and its length.

There is also provided in accordance with another preferred embodimentof the present invention an arthroscopic bone channel forming andsuturing system including a punch configured to form a first generallystraight channel in a bone, a drill configured to form a secondgenerally straight channel in the bone, the second generally straightchannel not intersecting the first generally straight channel, a curvedneedle configured to be insertable into the first generally straightchannel, a needle driving assembly configured to manipulate the curvedneedle to form a curved junction between the first generally straightchannel and the second generally straight channel and a suture assemblyconfigured to insert a suture to a suture pick-up location via thesecond generally straight channel in the bone, the curved needle beingconfigured to pull the suture from the suture pick up location andthrough the junction and the first generally straight channel.

Preferably, the curved needle has a radius of curvature which isgenerally equal to or greater than a length of the first generallystraight channel.

There is further provided in accordance with yet another preferredembodiment of the present invention an arthroscopic bone channel formingand suturing method including forming a first channel in a bone,inserting a curved needle into the first channel, forming a secondchannel in the bone by using a straight drill extending through astraight working channel, removing the drill from the working channel,inserting a suture through the working channel extending through thesecond channel in the bone to a suture pick-up location and pulling thesuture by the curved needle from the suture pick-up location though thefirst channel.

Preferably, the method also includes forming a single incision in apatient's body for insertion and removal of the curved needle and thedrill. Additionally, the inserting a suture includes locating a foldedover portion of the suture at the suture pick-up location and free endsof the suture remain outside of the incision.

In accordance with a preferred embodiment of the present invention thesecond channel is substantially longer than the first channel.

Preferably, the curved needle has a radius of curvature which isgenerally equal to or greater than a length of the first channel.Additionally or alternatively, the geometry of the curved needle and thegeometry of the first channel are such that the curved needle can passthrough the first channel without changing the configuration of thefirst channel to add curvature thereto. Additionally, the geometry ofthe curved needle includes its width and its inner and outer radii ofcurvature and wherein the geometry of the first channel includes itswidth and its length.

There is even further provided in accordance with still anotherpreferred embodiment of the present invention an arthroscopic bonechanneling and suturing system including a punch configured to form afirst channel in a bone, a straight drill extending through a straightworking channel and being adapted to form a second channel and to insertthe working channel in the straight channel in the bone, a needledriving assembly configured to insert a tunneling needle into the firstchannel and a suture assembly configured to insert a suture through theworking channel and through the second channel in the bone to a suturepick-up location, the needle driving assembly being configured toretract the tunneling needle together with the suture from the suturepick-up location though the first channel.

Preferably, the drill is removable from the working channel to allowinsertion of the suture assembly into the working channel. Additionallyor alternatively, the drill is formed with a drill bit configuration ata forward end thereof.

In accordance with a preferred embodiment of the present invention thesuture assembly includes a pair of forward arms and the suture loopedover the pair of forward arms.

In accordance with a preferred embodiment of the present invention theneedle driving assembly is configured to drive the tunneling needlethrough the bone from the first channel to the suture pick-up location.

Preferably, the tunneling needle includes a suture engagement grooveconfigured to retain the suture and pull the suture from the suturepick-up location through the first channel. Additionally, thearthroscopic bone channeling and suturing device also includes a suturetensioning assembly and the suture is configured to slide intoengagement with the suture engagement groove by tension provided by thetensioning assembly.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will be understood and appreciated from thefollowing detailed description, taken in conjunction with the drawingsin which:

FIGS. 1A & 1B are simplified pictorial illustrations of an arthroscopicsurgical assembly constructed and operative in accordance with apreferred embodiment of the present invention, showing opposite views;

FIGS. 2A & 2B are simplified pictorial illustrations of an arthroscopicsurgical device forming part of the arthroscopic surgical assembly ofFIGS. 1A & 1B, constructed and operative in accordance with a preferredembodiment the present invention, showing opposite views in a firstoperative orientation;

FIGS. 3A & 3B are simplified pictorial illustrations of an arthroscopicsurgical device constructed and operative in accordance with a preferredembodiment of the present invention, showing opposite views in a secondoperative orientation;

FIGS. 4A & 4B are simplified pictorial illustrations of an arthroscopicsurgical device constructed and operative in accordance with a preferredembodiment of the present invention, showing opposite views thirdoperative orientation;

FIGS. 5A & 5B are simplified pictorial illustrations of an arthroscopicsurgical device constructed and operative in accordance with a preferredembodiment of the present invention, showing opposite views in a fourthoperative orientation;

FIGS. 6A & 6B are simplified pictorial illustrations of an arthroscopicsurgical device constructed and operative in accordance with a preferredembodiment of the present invention, showing opposite views in a fifthoperative orientation;

FIGS. 7A & 7B are simplified pictorial illustrations of an arthroscopicsurgical device constructed and operative in accordance with a preferredembodiment of the present invention, showing opposite views in a sixthoperative orientation;

FIGS. 8A & 8B are simplified pictorial illustrations of an arthroscopicsurgical device constructed and operative in accordance with a preferredembodiment of the present invention, showing opposite views in a seventhoperative orientation;

FIGS. 9A & 9B are simplified pictorial illustrations of an arthroscopicsurgical device constructed and operative in accordance with a preferredembodiment of the present invention, showing opposite views in an eighthoperative orientation;

FIGS. 10A & 10B are simplified pictorial illustrations of anarthroscopic surgical device constructed and operative in accordancewith a preferred embodiment of the present invention, showing oppositeviews in a ninth operative orientation;

FIGS. 11A & 11B are simplified pictorial illustrations of anarthroscopic surgical device constructed and operative in accordancewith a preferred embodiment of the present invention, showing oppositeviews in a tenth operative orientation;

FIGS. 12A & 12B are simplified pictorial illustrations of anarthroscopic surgical device constructed and operative in accordancewith a preferred embodiment of the present invention, showing oppositeviews in an eleventh operative orientation;

FIGS. 13A & 13B are simplified pictorial illustrations of anarthroscopic surgical device constructed and operative in accordancewith a preferred embodiment of the present invention, showing oppositeviews in a twelfth operative orientation;

FIGS. 14A & 14B are simplified pictorial illustrations of anarthroscopic surgical device constructed and operative in accordancewith a preferred embodiment of the present invention, showing oppositeviews in an thirteenth operative orientation;

FIGS. 15A & 15B are simplified pictorial illustrations of anarthroscopic surgical device constructed and operative in accordancewith a preferred embodiment of the present invention, showing oppositeviews in a fourteenth operative orientation;

FIGS. 16A & 16B are simplified pictorial illustrations of anarthroscopic surgical device constructed and operative in accordancewith a preferred embodiment of the present invention, showing oppositeviews in a fifteenth operative orientation;

FIGS. 17A & 17B are simplified pictorial illustrations of anarthroscopic surgical device constructed and operative in accordancewith a preferred embodiment of the present invention, showing oppositeviews in a sixteenth operative orientation;

FIGS. 18A & 18B are simplified pictorial illustrations of anarthroscopic surgical device constructed and operative in accordancewith a preferred embodiment of the present invention, showing oppositeviews in a seventeenth operative orientation;

FIGS. 19A and 19B are respectively a simplified partially exploded viewillustration of part of the arthroscopic surgical device of FIGS. 1A-18Bin the first operative orientation and a fully exploded viewillustration of a portion of the part of the device shown in FIG. 19A;

FIG. 19C is a simplified illustration of another part of thearthroscopic surgical device of FIGS. 1A-19B;

FIGS. 19D and 19E are simplified illustrations, from two differentperspectives, of another part of the arthroscopic surgical device ofFIGS. 1A-19B;

FIG. 19F is a simplified sectional view of a portion of the arthroscopicsurgical device of FIGS. 1A-19B.

FIGS. 20A and 20B are simplified exploded view illustrations of aportion of the arthroscopic surgical device of FIGS. 1A-19F, showingopposite views;

FIG. 20C is a simplified partially assembled view of the portion of thearthroscopic surgical device of FIGS. 20A and 20B;

FIGS. 20D and 20E are simplified illustrations of the apparatus of FIGS.20A-20C in two different operative orientations;

FIGS. 21A and 21B are simplified illustrations of another portion of thearthroscopic surgical device of FIGS. 1A-19C, showing opposite views;

FIGS. 22A and 22B are simplified exploded view illustrations of theportion of the arthroscopic surgical device of FIGS. 21A & 21B, showingopposite views;

FIGS. 23A and 23B are simplified illustrations of part of the portion ofthe arthroscopic surgical device of FIGS. 21A & 21B;

FIGS. 24A and 24B are simplified assembled view illustrations of a drillportion of the arthroscopic surgical device of FIGS. 1A-19C, showingopposite views;

FIGS. 25A and 25B are simplified assembled view illustrations of asuture cartridge portion of the arthroscopic surgical device of FIGS.1A-24B, showing opposite views;

FIG. 25C is a simplified exploded view illustration of the suturecartridge portion of the arthroscopic surgical device shown in FIGS. 25Aand 25B;

FIG. 25D is a simplified side view illustration of the suture cartridgeportion of the arthroscopic surgical device shown in FIGS. 25A-25C;

FIGS. 26A and 26B are simplified assembled view illustrations of aworking channel portion of the arthroscopic surgical device of FIGS.1A-25D, showing opposite views;

FIG. 26C is a simplified exploded view illustration of the workingchannel portion of the arthroscopic surgical device shown in FIGS. 26Aand 26B;

FIGS. 27A, 27B, 27C, 27D, 27E, 27F, 27G, 27H, 27I, 27J, 27K, 27L, 27M,27N, 27O, 27P, 27Q and 27R are respective simplified illustrations ofdetails of the operation of the arthroscopic surgical device of FIGS.1A-26C; and

FIGS. 28A, 28B, 28C, 28D, 28E, 28F, 28G, 28H, 28I, 28J, 28K, 28L, 28M,28N, 28O, 28P, 28Q, 28R, 28S, 28T, 28U, 28V, 28W and 28X are simplifiedillustrations of operation of the arthroscopic surgical device of FIGS.1A-27R in a clinical context.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

It is appreciated that the terms ‘tunnel’ and ‘channel’ are usedinterchangeably in the description of the present invention and refer toa hollow bore, such as a cylindrically circular hollow bore, formed in abone. It is also appreciated that the terms ‘tunneling’ and ‘channeling’are used interchangeably in the description of the present invention andrefer to a method of forming a hollow bore, such as a cylindricallycircular hollow bore, in a bone.

It is further appreciated that the term “suture” as used throughout thedescription of the present invention refers to any suitable suture andalso refers to a transfer wire which is used to pull a suture throughthe bone. Typically, a transfer wire is used with the system and methodof the present invention and is formed of Nitinol. Typically, a transferwire used with the system and method of the present invention is foldedover to form a loop at one end.

Reference is now made to FIGS. 1A & 1B, which are simplified pictorialillustrations of an arthroscopic surgical assembly, constructed andoperative in accordance with a preferred embodiment of the presentinvention, showing opposite views, and to various additional drawingswhich are specifically referenced in parentheses hereinbelow.

As seen in FIG. 1B, there is provided a bone punch 10, preferablyincluding a handle portion 12, an intermediate portion 14, and a forwardportion 16, having a pointed tip 18. A line 20 is preferably formed onforward portion 16 to indicate a desired extent of bone penetration to asurgeon using the punch. A generally concave impact surface 22 ispreferably formed on a rearward end of punch 10, for impact thereon by asurgical hammer.

As seen in FIGS. 1A & 1B and shown specifically in FIGS. 2A & 2B, anarthroscopic surgical device 100 according to a preferred embodiment ofthe present invention includes a housing portion, preferably formed ofright and left housing elements 102 and 104, and a multiple actiondriving assembly 106, only part of which is seen in FIGS. 1A & 1B. Thehousing portion includes a handle portion, which is defined byrespective right and left housing element handle portions 112 and 114,respectively.

The multiple action driving assembly 106 preferably includes abone-engaging pin insertion assembly 120, a bone-engaging needle drivingassembly 122 and a selectable attachment assembly 123.

Bone-engaging pin insertion assembly 120 preferably includes a workingchannel assembly 124, which is shown and described in detail hereinbelowwith reference to FIGS. 26A-26C, and a drill 126, which is shown anddescribed in detail hereinbelow with reference to FIGS. 24A & 24B.

Referring now additionally to FIGS. 26A-26C, it is seen that the workingchannel assembly 124 includes a main longitudinal rigid tube 128,typically formed of stainless steel, and a hardened forward tube 130,typically formed of hardened stainless steel, which fits into a forwardend of main rigid tube 128. Preferably, welded onto a rear end of maintube 128 is a driving socket element 132 having formed, at a rear endthereof, a recess 134, typically having a hexagonal cross section.

Driving socket element 132 is rotatably mounted within a collar member136, which is shown and described in detail hereinbelow, with referenceto FIGS. 19A & 19B, and which is mounted onto the housing so as to havelimited axial movement with respect thereto. Driving socket element 132is restrained against axial movement relative to collar member 136,preferably by a pair of retaining pins 138, which extend throughtransverse apertures formed in collar member 136 and engage a groove 140formed in driving socket element 132.

Referring now additionally to FIGS. 24A-24B, it is seen that drill 126preferably comprises a solid rod 142 of circular cross section, having adrill bit configuration at a forward end 144 thereof and being formed ata widened rear end 146 thereof with a hexagonal cross section, such thatrear end 146 is suitable for drivable engagement with a chuck of aconventional surgical drill (not shown).

The bone-engaging needle driving assembly 122 preferably includes ahand-engageable ratchet handle 150 which is arranged for reciprocalmotion about an axis 152 (FIG. 19B). A selectable direction ratchetshaft 156 (FIG. 19B) extends through slots 158 in respective right andleft housing element handle portions 112 and 114, and terminates inknobs 160, whose positions in slots 158 govern the direction of motionof an arthroscopic arcuate tunneling needle 162 having a sutureengagement groove 164 partially defined by a needle end portion 165.

As noted above, it is appreciated that the terms ‘tunneling’ and‘channeling’ are used interchangeably in the description of the presentinvention and refer to a method of forming a hollow bore, such as acylindrically circular hollow bore, in a bone.

A visible mechanical indicator 166 is preferably arranged on the top ofrespective housing portions 102 and 104. Indicator 166 preferablyprovides a visible indication of the extent that arcuate tunnelingneedle 162 is displaced from its fully retracted position shown in FIGS.2A & 2B.

A suture cartridge assembly 170 is provided for selectable engagementwith the housing and is illustrated in FIGS. 25A-25D. Suture cartridgeassembly 170 preferably includes a longitudinal tube 172 having aspecially configured forward end 174. As seen particularly in FIG. 25C,the forward end 174 is configured to have a pair of mutually spacedforwardly extending arms 176 which are each formed with a sutureretaining end notch 178 and a suture retaining side notch 180. Atransverse slot 182 is formed rearwardly of arms 176 to enable a foldedover suture 184 which extends through a longitudinal bore inlongitudinal tube 172 to be looped over arms 176 at notches 178 and 180as shown in FIG. 25A.

As noted above, it is appreciated that the term “suture” as usedthroughout the description of the present invention refers to anysuitable suture and also refers to a transfer wire which is used to pulla suture through the bone. Typically, a transfer wire is used with thesystem and method of the present invention and is formed of Nitinol.

Mounted at a rearward end 185 of tube 172, there is provided aselectable suture tensioning assembly 186. Assembly 186 includes anassembly housing 187 onto which is pivotably mounted a user-operablesuture release lever 188, which, in turn, operates a pivotably mountedrelease element 189. Release element 189 selectably retains the assemblyhousing 187 against rearward axial movement under the urging of acompression spring 190. Frictional engagement between a screw 191,threaded into engagement with a retaining member 192, and a transverselyextending rod 193 maintains tension on the suture 184 up to apredetermined threshold force beyond which the ends of the suture 184become released from assembly 186. Rod 193 engages a pair of slots 194on opposite sides of assembly housing 187 and extends through atransverse aperture 195 in retaining member 192.

A pivot pin 196 pivotably mounts release lever 188 onto assembly housing187. A pusher pin 197, mounted onto release lever 188, engages releaseelement 189 and produces pivoted movement thereof about a pivot pin 198,fixed to housing 187, in response to pressing on release lever 188. Alatch pin 199, fixed onto assembly housing 187 selectably engagesrelease element 189.

The operation of selectable suture tensioning assembly 186 may besummarized as follows. Insertion of the suture cartridge assembly 170into engagement with collar member 136 causes release element 189 to belatched to collar member 136. Downward pushing on release lever 188produces pivotal motion of release element 189, which pushes spring 190rearwardly against retaining member 192. This produces retraction oftube 172 and of arms 176 and tensions the forward folded over end ofsuture 184 and draws it tightly into engagement with arcuate tunnelingneedle 162, which is adapted to selectably engage suture 184 atneedle-suture engagement location located between arms 176. The freeends of the suture 184 thereafter become released from the suturetensioning assembly 186 in response to retraction of the needle 162along its arcuate path, which produces tensile force on the suture 184which overcomes the grip between rod 193 and screw 191 produced byspring 190.

It is appreciated that free ends of suture 184 remain outside of anincision made in a patient's body before, during and after the insertionprocedure described hereinbelow with reference to FIGS. 27A-27R and28A-28X.

Reference is now made to FIGS. 3A & 3B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-2B in asecond operative orientation. It is seen that the transition from thefirst operative orientation of FIGS. 2A & 2B to the second operativeorientation, which preferably occurs following insertion of a forwardportion of the bone-engaging needle driving assembly 122 through anarthroscopic incision, as described hereinbelow with reference to FIGS.28E and 27B, involves shifting the position of knobs 160 from a loweredposition to a raised position in slot 158.

Reference is now made to FIGS. 4A & 4B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-3B in athird operative orientation and which illustrate partial extension ofarcuate tunneling needle 162, as indicated by indicator 166. Thisextension is produced by rotation of hand-engageable ratchet handle 150about axis 152 (FIG. 19B) when knobs 160 are in the upper position inslots 158. Needle 162 enters a channel earlier formed in a humerus, aswill be described hereinbelow with reference to FIGS. 27C & 28H.

Reference is now made to FIGS. 5A & 5B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-4B in afourth operative orientation and which show insertion of thebone-engaging pin insertion assembly 120 through the housing of thearthroscopic surgical device 100 of FIGS. 4A & 4B so that tip 144extends nearly to the surface of the bone, as described hereinbelow withreference to FIGS. 27D and 28I.

Reference is now made to FIGS. 6A & 6B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-5B in afifth operative orientation. It is seen that the widened rear end 146 ofbone-engaging pin insertion assembly 120 is engaged by the chuck of asurgical drill 200, as described hereinbelow in detail with reference toFIGS. 27E and 28J.

Reference is now made to FIGS. 7A & 7B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-6B in asixth operative orientation. It is seen that due to operation ofsurgical drill 200, the forward tip 144 of the drill 126 is fullyextended, as described hereinbelow in detail with reference to FIGS. 27Fand 28K. It is seen that concomitantly, due to the operation of surgicaldrill 200, working channel assembly 124, including collar member 136,has moved to its full axially forward position with respect to theselectable attachment assembly 123. It is noted, as will be describedhereinbelow, that collar member 136 is automatically latched toselectable attachment assembly 123 at this stage.

Reference is now made to FIGS. 8A & 8B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-7B in aseventh operative orientation. Here it is seen that the drill 126 isbeing retracted but that working channel assembly 124 remains in itsfull axially forward position, by virtue of latching of collar member136 to selectable attachment assembly 123.

Reference is now made to FIGS. 9A & 9B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-8B in aneighth operative orientation and illustrate insertion of the suturecartridge assembly 170 through the working channel assembly 124. It isnoted that selectable suture tensioning assembly 186 is automaticallylatched to collar member 136.

Reference is now made to FIGS. 10A & 10B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-9B in aninth operative orientation and which illustrate full extension ofarcuate tunneling needle 162, as indicated by indicator 166. Thisextension is produced by rotation of hand-engageable ratchet handle 150about axis 152 (FIG. 19B) when knobs 160 are in the upper position inslots 158.

It is seen that arcuate tunneling needle 162 extends between mutuallyspaced forwardly extending arms 176 of suture cartridge assembly 170. Asnoted above, each of arms 176 is formed with a suture retaining endnotch 178 and a suture retaining side notch 180. A transverse slot 182is formed rearwardly of arms 176 to enable a folded over suture 184which extends through a longitudinal bore in longitudinal tube 172 to belooped over arms 176 at notches 178 and 180 as shown in FIG. 25A. It isfurther seen that suture engagement groove 164 lies below mutuallyspaced forwardly extending arms 176 of suture cartridge assembly 170.

Reference is now made to FIGS. 11A & 11B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-10B in atenth operative orientation. It is seen that lever 188 is manuallydepressed, thereby unlatching suture tensioning assembly 170 from collarmember 136 and causing axially rearward displacement of suturetensioning assembly 170 relative to collar member 136 and concomitantaxial retraction of arms 176 of suture cartridge assembly 170 relativeto working channel 124. It is seen that suture 184 is looped aroundneedle 162 at a location on needle 162 lying above suture engagementgroove 164.

Reference is now made to FIGS. 12A & 12B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-11B in aneleventh operative orientation. It is seen knobs 160 are lowered totheir lower position in slots 158.

Reference is now made to FIGS. 13A & 13B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-12B in atwelfth operative orientation. It is seen that needle 162 is partiallyretracted so that it engages suture 184 at suture engagement groove 164.

Reference is now made to FIGS. 14A & 14B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-13B in athirteenth operative orientation. It is seen that arcuate tunnelingneedle 162 is fully retracted, as indicated by indicator 166, inengagement with the forward looped end of suture 184, thus drawing thesuture backwards along an arcuate path along with full retraction of theneedle 162.

Reference is now made to FIGS. 15A & 15B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-14B in afourteenth operative orientation. It is seen that suture cartridgeassembly 170 is fully retracted and withdrawn from the working channelassembly 124, leaving the suture 184 in the working channel assembly124.

Reference is now made to FIGS. 16A & 16B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-15B in afifteenth operative orientation. It is seen that the working channelassembly 124 is partially axially retracted by rotation of theselectable attachment assembly 123, which forces collar member 136axially rearwardly, thus drawing hardened forward tube 130 rearwardlyout of tight engagement with the bone.

Reference is now made to FIGS. 17A & 17B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-16B in asixteenth operative orientation. It is seen that working channelassembly 124 is fully retracted and that the positions of knobs 160 inslots 158 are shifted upwardly, in order to provide extension of needle162 in response to operation of ratchet handle 150. The orientation ofthe needle 162 is shown by indicator 166.

Reference is now made to FIGS. 18A & 18B, which are simplified pictorialillustrations of the arthroscopic surgical device of FIGS. 1A-17B in aseventeenth operative orientation. It is seen that the arcuate tunnelingneedle 162 is now partially extended in order to permit manualdisengagement of the looped forward end of suture 184 from sutureengagement groove 164 of needle 162.

Reference is now made to FIGS. 19A-24B and initially specifically toFIGS. 19A & 19B and to FIGS. 20A and 20B, which are simplified explodedview illustrations of a portion of the arthroscopic surgical device ofFIGS. 1A-18B, showing opposite views, to FIG. 20C, which is a simplifiedpartially assembled view, and to FIGS. 20D and 20E, which are simplifiedillustrations of the apparatus of FIGS. 20A-20C in two differentoperative orientations, all of which show details of some elements ofmultiple action driving assembly 106.

It is seen that ratchet handle 150 is typically formed with a loweraperture 210, which accommodates a shaft 154, and a slot 212. A pin 214is slidably movable in slot 212, such that reciprocal arcuate motion ofslot 212 is translated into reciprocal planar forward and rearwardmotion perpendicular to a longitudinal axis 216 of pin 214. First andsecond reciprocal motion connection elements 220 and 222 are fixed topin 214 at respective apertures 224 and 226 and move together therewithin reciprocal forward and rearward linear motion in response torotational motion of ratchet handle 150.

Connection element 222 includes an elongate protrusion 228, which movesreciprocally in a slot 230 formed in housing portion 102.

Connection element 220 includes a side extending shaft 240 which isformed with a circumferential groove 244 onto which is mounted one endof a tension spring 248. An opposite end of tension spring 248 ismounted in a circumferential groove 250 formed in shaft 156. Shaft 156extends through an aperture 254 formed in a toggle element 256, whichcommunicates with a hollow shaft portion 258 of toggle element 256.Shaft 156 extends through slots 158 formed on respective housingportions 102 and 104.

A double rack linear toothed element 270 is provided with an upperlinear toothed ratchet rack 272 and a lower linear toothed gear rack274. A pointed corner 275 of connection element 220 selectably engagesupper linear toothed rack 272. Double rack linear toothed element 270 ispreferably formed with a slot 276 which engages an elongate axialprotrusion 277 formed in housing element 102.

An inward recessed portion 278 adjacent an inner end of a generallyrigid flexible needle driving strip driving shaft 280 is fixedly mountedonto double rack linear toothed element 270 by means of a mountingelement 282, which is typically bolted onto element 270. An indicatorfinger 284 is formed on mounting element 282 and forms part of indicator166.

A second double rack linear toothed element 285 is provided with anupper linear toothed gear rack 286 and a lower linear toothed ratchetrack 287. Double rack linear toothed element 285 is preferably formedwith a slot 288, which engages an elongate axial protrusion 289 formedin housing element 102.

A gear 290, having a gear shaft 291, engages lower linear toothed gearrack 274 of element 270 and also simultaneously engages upper lineartoothed gear rack 286 of element 285. Gear shaft 291 preferably ismounted at its opposite ends in apertures 292 in respective housingelements 102 and 104.

A pointed corner 293 of connection element 220 selectably engages lowerlinear toothed ratchet rack 287 of element 285.

Reference is now made specifically to FIGS. 19A-19F and 20A-20E, whichillustrate the structure of selectable attachment assembly 123. As seenwith particularity in FIGS. 19A, 19C & 19F, the selectable attachmentassembly 123 comprises a winged nut 294 having a threaded bore 295extending therealong from a first end 296 of nut 294 to acircumferential recess 297 which is spaced from a second end 298 of nut294 by a non-threaded bore portion 299.

As seen in FIGS. 19A and 19D-19F, a connection element 300 is arrangedfor threaded engagement with threaded bore 295 of winged nut 294.Connection element 300 includes a first generally cylindrical portion301 having a throughgoing axial bore 302 and a throughgoing bottom slit303 formed therein. A threaded generally cylindrical collar portion 304is located at an intermediate location along connection element 300forwardly of first generally cylindrical portion 301 in the sense ofFIG. 19A. A second generally cylindrical portion 305 is locatedforwardly of collar portion 304 and has a cross sectional diameter whichis greater than that of first cylindrical portion and less than that ofcollar portion 304.

Forward of second generally cylindrical portion 305 there are preferablyprovided a pair of spaced lugs 306 which are separated by a verticalrecess 307. Connection element 300 also includes an aperture 308, formedin generally cylindrical portion 301, in which is seated an axialguiding pin 309.

A latch element 310 includes a forward portion 311, having a toptransverse bore 312 through which extends a transverse pin 313 forpivotable attachment of latch element 310 to connection element 300 vialugs 306. Latch element 310 also includes a rearwardly facing latchextension portion 314 which is seated in throughgoing bottom slit 303and includes a depending latch protrusion 315, at a rearward endthereof, for removable latched engagement with collar member 136 ofworking channel assembly 124.

Forward portion 311 also includes a bottom transverse bore 316 whichaccommodates a pin 317, onto which is connected a first end of a tensionspring 318, whose opposite end is connected to a pin 319 which ismounted at opposite ends thereof at respective locations 320 in rightand left housing elements 102 and 104.

Transverse pin 313 is mounted at opposite ends thereof at respectivelocations 321 in right and left housing elements 102 and 104.

Forward portion 311 is also formed with an aperture 322 foraccommodating working channel assembly 124, which extends therethrough.

Returning now to the description of the working channel assembly 124 ingreater detail and referring now additionally to FIGS. 26A-26C, asmentioned above, working channel assembly 124 includes a mainlongitudinal rigid tube 128 and a hardened forward tube 130. Drivingsocket element 132 is preferably welded onto a rear end of main tube 128and is rotatably mounted within collar member 136. Driving socketelement 132 is restrained against axial movement relative to collarmember 136, preferably by a pair of retaining pins 138, which extendthrough transverse apertures formed in collar member 136 and engage agroove 140 formed in driving socket element 132.

Turning specifically to FIG. 26C, it is seen that socket element 132 isa generally cylindrical element which has a non-circular driving bore134, typically of hexagonal cross section, extending partiallytherethrough from a rear end 323 of socket element 132. A narrow bore324 extends forwardly of driving bore 134 and extends into a broadenedbore 325 which terminates at a forward circumferential recess 326.External circumferential recess 140 surrounds part of broadened bore325.

Collar member 136 includes a generally cylindrical back portion 327having a bore 328 which is intersected by pins 138 extending throughtransverse apertures 329 in cylindrical back portion 327. A narrow bore330 extends forwardly of bore 328 and communicates with a recess 332.Cylindrical back portion 327 is also formed with an axial bottom groove334 having side lobes 336 and communicating with a transverse aperture337.

Forward of back portion 327 is a generally cylindrical forward portion338 having an axial slot 340 which extends partially into cylindricalback portion 327 as shown at reference numeral 342. Axial guiding pin309 of connection element 300 engages axial slot 340 to ensure properrotational alignment of working channel assembly 124 and to ensureproper alignment of suture cartridge assembly 170.

The assembly of socket element 132 inside collar member 136 and themounting therein of main longitudinal rigid tube 128 is shown in anenlarged sectional portion of FIG. 26A.

Reference is now made specifically to FIGS. 21A-24B, which illustratebone-engaging needle driving assembly 122. The bone-engaging needledriving assembly 122 includes linear gear rack element 270, which ispreferably driven along an elongate travel path responsive to reciprocalmotion of ratchet handle 150.

Bone-engaging needle driving assembly 122 includes a static forwardportion 400, including a mounting base 402, which extends forwardly of aforward end of the housing, which is fixed to an extension shaft 404extending axially inwardly thereof and forwardly therefrom. Fixed toextension shaft 404 and extending forwardly thereof, there is preferablyformed an arcuate needle storage and guiding portion 406.

Mounting base 402 is generally configured as a hollow cylinder toaccommodate part of extension shaft 404 therewithin and is formed withmatching side apertures 408 which accommodate mounting pins 410 (FIG.19B), which serve to mount the mounting base 402 onto housing portions102 and 104, as seen in FIG. 19B.

Extension shaft 404 is preferably formed of two side by side pieces 411.Side pieces 411 together define two mutually spaced axial mounting boresextending therethrough, which bores are designated by reference numerals412 and 414. Bore 412 slidably accommodates working channel assembly 124and has a generally round cross-section.

Bore 414 slidably accommodates parts of a flexible arcuate needledriving assembly, which preferably includes a flexible needle drivingstrip 418, preferably formed of spring steel, and generally rigidflexible needle driving strip driving shaft 280, which is mounted at therear of flexible needle driving strip 418, preferably as shown inenlargements A & B in FIG. 21A. This mounting is preferably by means ofengagement of a protrusion 419 formed adjacent the forward end of rigidflexible needle driving strip driving shaft 280 with a correspondingaperture 420 formed adjacent a rearward end of flexible needle drivingstrip 418.

As seen in enlargement A of FIG. 21A, bore 414 has a generally circularcross sectional central portion 422 to accommodate shaft 280, from whichportion extend a pair of symmetrical side cut outs 424 to accommodatethe side edges of strip 418.

As seen particularly in enlargement D of FIG. 21A, forward of extensionshaft 404, there is preferably formed an arcuate needle storage andguiding portion 450, which is formed with an arcuate bore 452 includinga portion 454 having a generally rectangular cross section, whichslidably accommodates needle 162. A pair of symmetrical side cut outs456 extend outwardly from portion 454 and accommodate the side edges offlexible needle driving strip 418.

It is also seen in an enlargement of FIG. 22A, that the forward end offlexible needle driving strip 418 is attached to arcuate needle 162.This attachment is preferably by means of engagement of a protrusion 466formed adjacent the rearward end of arcuate needle 162 with acorresponding aperture 467 formed adjacent a forward end of flexibleneedle driving strip 418.

Reference is now made to FIGS. 27A, 27B, 27C, 27D, 27E, 27F, 27G, 27H,27I, 27J, 27K, 27L, 27M, 27N, 27O, 27P, 27Q and 27R, which illustratedetails of the operation of the arthroscopic surgical device of FIGS.1A-26C, and to FIGS. 28A, 28B, 28C, 28D, 28E, 28F, 28G, 28H, 28I, 28J,28K, 28L, 28M, 28N, 28O, 28P, 28Q, 28R, 28S, 28T, 28U, 28V, 28W and 28X,which are simplified illustrations of operation of the arthroscopicsurgical device of FIGS. 1A-27R in a clinical context.

Reference is initially made to FIGS. 28A-28D, which show an initial stepof using punch 10 (FIG. 1B) to form a channel 499 in a bone, such as ahumerus. A surgeon positions punch 10 opposite an appropriatearthroscopic incision 500 in a patient, as shown in FIGS. 28A and 28B.As seen in FIG. 28C, using a surgical hammer which impacts on impactsurface 22 of punch 10, the surgeon forces the forward portion 16 of thepunch 10 into the humerus up to line 20. The punch is then withdrawnfrom the patient, leaving channel 499 in the humerus, as shown in FIG.28D. FIG. 28E illustrates initial insertion of the arthroscopic surgicaldevice of FIGS. 2A & 2B, in a first operative orientation, as shown inFIG. 27A, through an arthroscopic incision 501 adjacent to incision 500.

Reference is now made to FIGS. 27B and 28F which illustrate shifting ofknobs 160 in slots 158 to their upward positions.

Reference is now made to FIG. 27C and FIG. 28G, which correspond toFIGS. 4A & 4B and show extending of the needle 162, by squeezing ofhandle 150 as indicated by an arrow 502 and positioning of the extendedforward portion of needle 162 in channel 499 in the humerus. FIG. 28Hshows the forward portion of needle 162 fully inserted in channel 499.

As seen in FIG. 28C, needle 162 preferably has a radius of curvaturewhich is generally equal to or greater than a length of channel 499.Additionally, it is appreciated that the geometry of needle 162,including its width and inner and outer radii of curvature, and thegeometry of channel 499, including its length and width, are such thatneedle 162 can pass through channel 499 without changing theconfiguration of channel 499 to add curvature thereto.

Reference is now made to FIGS. 27D and 28I, which show drill 126, suchas that described hereinabove with reference to FIGS. 20A & 20B, beingmounted onto the arthroscopic surgical device 100 and being initiallypositioned, as indicated by an arrow 503, to a position wherein the tip144 touches the outside surface of the humerus.

FIGS. 27E and 28J, which correspond generally to FIGS. 6A & 6B, showattachment of surgical drill 200 to widened rear end 146 of drill 126.

FIGS. 27F and 28K, which correspond generally to FIGS. 7A & 7B, showlinear forward displacement of drill 126 and working channel assembly124 of bone-engaging pin insertion assembly 120 in the arthroscopicsurgical device 100, as indicated by an arrow 504. This displacement ispreferably achieved by operation of the surgical drill 200 in operativeengagement with widened rear end 146 of drill 126. As seen in FIG. 28K,the tip 144 of drill 126 is in its most forward position and tube 130 isin its most forward position.

FIGS. 27G and 28L, which correspond generally to FIGS. 8A & 8B, showretraction of the drill 126, as indicated by an arrow 505, while leavingthe tube 130 in its most forward position.

As seen in FIG. 28L, a channel formed in the humerus by drill 126 ispreferably longer, and more preferably, substantially longer, thanchannel 499 formed in the humerus by punch 10. It is also seen in FIG.28L that the channel formed in the humerus by drill 126 does notintersect channel 499.

Additionally, it is appreciated that the channel formed in the humerusby drill 126 and channel 499 formed in the humerus by punch 10 are notparallel channels. Preferably, an angle formed between the channelformed in the humerus by drill 126 and an extension of channel 499formed in the humerus by punch 10 is generally a right angle or an acuteangle greater than 45°.

Reference is now made to FIGS. 27H and 28M, which correspond generallyto FIGS. 9A and 9B and which show insertion of the suture cartridgeassembly 170, including suture 184, in engagement with the workingchannel assembly 124, such that arms 176 of suture cartridge assembly170 extend forwardly of a forward edge of tube 130.

Reference is now made to FIGS. 27I and 28N, which correspond generallyto FIGS. 10A & 10B and show full extension of arcuate tunneling needle162 through the bone, as indicated by indicator finger 284 of indicator166. This full extension is produced by squeezing of handle 150, asindicated by an arrow 506. It is seen that this squeezing ofhand-engageable ratchet handle 150 produces rotation thereof, asindicated by arrow 506, about a rotational axis defined by shaft 154and, via pin 214, displaces first reciprocal motion connection element220 linearly forwardly, as indicated by an arrow 520, with pointedcorner 275 of connection element 220 in engagement with upper lineartoothed rack 272 of double rack linear toothed element 270, therebydriving element 270 and needle driving strip driving shaft 280 forwardlyand causing arcuate needle 162, driven thereby, to travel along anarcuate path through the portion 454 of arcuate bore 452 having arectangular cross section and to extend outwardly into tunnelingengagement with the bone, as indicated by an arrow 522.

As seen in FIG. 28N, movement of needle 162 forms a curved junctionbetween channel 499 and the channel formed by drill 126.

It is seen that suture engagement groove 164 of arcuate needle 162,which is partially defined by end portion 165, extends between arms 176rearward of a forward end of suture 184.

Reference is now made to FIGS. 27J and 28O, which correspond generallyto FIGS. 11A & 11B and show partial retraction of the suture cartridgeassembly 170 relative to the working channel assembly 124, as indicatedby an arrow 530, in response to manual depression of a user-operablesuture release lever 188. This retraction causes the forward folded overend of suture 184 to press rearwardly against needle 162.

FIGS. 27K and 28P, which correspond generally to FIGS. 12A & 12B, showdownward repositioning of knob 160, as indicated by an arrow 532.

FIGS. 27L and 28Q, which correspond generally to FIGS. 13A & 13B, showarcuate retraction of arcuate tunneling needle 162, as indicated by anarrow 534, through the bone, driven by further squeezing of handle 150as indicated by an arrow 535. The forward folded over end of suture 184is seen to be in engagement with groove 164 of needle 162, and to beretained therein by end portion 165 of needle 162, such that retractionof the needle 162 pulls the suture 184 together with it along thearcuate travel path of the needle 162.

FIGS. 27M & 28R, which correspond generally to FIGS. 14A & 14B, showfull retraction of arcuate tunneling needle 162 in engagement withsuture 184, thereby pulling suture 184 through the arcuate passagewaybeing traversed by arcuate needle 162. This retraction is provided byfurther squeezing of handle 150, as indicated by arrow 535. The completeretraction of arcuate tunneling needle 162 is indicated by indicatorfinger 284 of indicator 166. At this stage, suture 184, in doubled-overconfiguration, extends entirely through the bone along the arcuate pathtunneled by needle 162 through the curved junction formed in the bone byneedle 162 and through channel 499. At this stage, the suture 184 issecurely retained in engagement with groove 164 of needle 162.

FIGS. 27N and 28S, which correspond generally to FIGS. 15A & 15B, showthe arthroscopic surgical device of FIGS. 1A-26C following completeremoval and disengagement of the suture cartridge assembly 170 anddisengagement of the free ends of the suture 184 therefrom.

FIGS. 27O and 28T, which correspond generally to FIGS. 16A & 16B, showpartial retraction of tube 130 produced by rotation of winged nut 294.

FIGS. 27P and 28U, which correspond generally to FIGS. 17A & 17B, showcomplete retraction of tube 130.

FIG. 28V shows removal of the arthroscopic surgical device from the bodyfrom the patient through incision 501, leaving the suture 184 extendingthrough the bone.

FIGS. 27Q and 28W show upward repositioning of knob 160, as indicated byan arrow 536.

FIGS. 27R and 28X, which correspond generally to FIGS. 18A & 18B, showdetachment of the suture 184 from arcuate tunneling needle 162 followingextension thereof in response to further squeezing of handle 150, asindicated by an arrow 538.

It is appreciated that following detachment of folded over portion ofsuture 184 from needle 162 free ends of suture 184 are pulled throughworking channel assembly 124. As noted above, it is appreciated thatfree ends of suture 184 remain outside of incision 501 before, duringand after the insertion procedure described above with reference toFIGS. 27A-27R and 28A-28X.

It will be appreciated by persons skilled in the art that the presentinvention is not limited by what has been particularly shown anddescribed hereinabove. Rather the scope of the present inventionincludes both combinations and subcombinations of the various featuresdescribed hereinabove as well as modifications thereof which would occurto persons skilled in the art upon reading the foregoing description andwhich are not in the prior art.

1. An arthroscopic bone channel forming and suturing method comprising:forming a first generally straight channel in a bone; inserting a curvedneedle into said first generally straight channel; forming a secondgenerally straight channel in said bone, said second generally straightchannel not intersecting said first generally straight channel;inserting a suture through said second generally straight channel insaid bone to a suture pick-up location; manipulating said curved needleto form a curved junction between said first generally straight channeland said second generally straight channel; and pulling said suture bysaid curved needle from said suture pick-up location through saidjunction and though said first generally straight channel.
 2. Anarthroscopic bone channel forming and suturing method according to claim1 and wherein said inserting said suture comprises locating a foldedover end of said suture at said suture pick-up location.
 3. Anarthroscopic bone channel forming and suturing method according to claim1 and wherein free ends of said suture extend outside of said secondchannel.
 4. An arthroscopic bone channel forming and suturing methodaccording to claim 1 and wherein said second generally straight channelis substantially longer than said first generally straight channel. 5.An arthroscopic bone channel forming and suturing method according toclaim 1 and wherein said curved needle has a radius of curvature whichis generally equal to or greater than a length of said first generallystraight channel.
 6. An arthroscopic bone channel forming and suturingmethod according to claim 1 and wherein the geometry of said curvedneedle and the geometry of said first generally straight channel aresuch that said curved needle can pass through said first generallystraight channel without changing the configuration of said firstgenerally straight channel to add curvature thereto.
 7. An arthroscopicbone channel forming and suturing method according to claim 6 andwherein said geometry of said curved needle includes its width and itsinner and outer radii of curvature and wherein said geometry of saidfirst generally straight channel includes its width and its length. 8-9.(canceled)
 10. An arthroscopic bone channel forming and suturing methodcomprising: forming a first channel in a bone; inserting a curved needleinto said first channel; forming a second channel in said bone by usinga straight drill extending through a straight working channel; removingsaid drill from said working channel; inserting a suture through saidworking channel extending through said second channel in said bone to asuture pick-up location; and pulling said suture by said curved needlefrom said suture pick-up location though said first channel.
 11. Anarthroscopic bone channel forming and suturing method according to claim10 and also comprising forming a single incision in a patient's body forinsertion and removal of said curved needle and said drill.
 12. Anarthroscopic bone channel forming and suturing method according to claim11 and wherein: said inserting a suture comprises locating a folded overportion of said suture at said suture pick-up location; and free ends ofsaid suture remain outside of said incision.
 13. An arthroscopic bonechannel forming and suturing method according to claim 10 and whereinsaid second channel is substantially longer than said first channel. 14.An arthroscopic bone channel forming and suturing method according toclaim 10 and wherein said curved needle has a radius of curvature whichis generally equal to or greater than a length of said first channel.15. An arthroscopic bone channel forming and suturing method accordingto claim 10 and wherein the geometry of said curved needle and thegeometry of said first channel are such that said curved needle can passthrough said first channel without changing the configuration of saidfirst channel to add curvature thereto.
 16. An arthroscopic bone channelforming and suturing method according to claim 15 and wherein saidgeometry of said curved needle includes its width and its inner andouter radii of curvature and wherein said geometry of said first channelincludes its width and its length. 17-23. (canceled)